Giemsa Staining Findings and Clinical Characteristics of Viral Keratitis in a Tertiary Care Centre

Malvika S B Mutt, Shantala Chinnakar, Varsha S, Dhananjaya K H
Author(s)
1Senior Resident, Department of Ophthalmology, Shri Atal Bihari Vajpayee Medical College and Research Center, Bowring Medical Hospital, Bengaluru, Karnataka, India. 2Senior Resident, Department of Ophthalmology, BGS Global Institute of Medical Sciences, Kengeri, Bengaluru, Karnataka, India. 3Assistant Professor, Department of Ophthalmology, Shri Atal Bihari Vajpayee Medical College and Research Center, Bowring Medical Hospital, Bengaluru, Karnataka, India

Abstract

Background: Herpes simplex virus is the most common cause of viral keratitis which can recur and cause progressive corneal damage and visual loss. Diagnosis is mainly clinical but Giemsa staining is a simple and cheap supportive test in resource-limited areas. Hence, the present study aimed to assess the positivity of Giemsa stain, pre-triggering factors, frequency of recurrence and epithelial or stromal pattern of recurrent viral keratitis in a tertiary care centre. Material and Methods: This was a prospective observational study of 72 cases of clinically diagnosed viral keratitis during one year at a tertiary care centre. Patients were evaluated in detail after informed consent, slit-lamp examination, fluorescein staining, visual acuity, and appropriate laboratory investigations. Corneal scrapings from the cases of epithelial keratitis were stained with Giemsa stain to look for the presence of multinucleated giant cells. Triggering factors and recurrence were recorded and data were analysed with descriptive statistics in SPSS. Results: Of 72 patients with viral keratitis, 34.7% were 10-20 years old, 54.2% were male and 87.5% were from urban areas. Unilateral involvement was seen in 62.5% with redness (68.1%) and decrease in vision (50.0%) being the most frequent symptoms. Epithelial keratitis predominated (72.2%). Epithelial cases showed positivity in 28.8% of the cases using Giemsa stain. Few triggers were identified (16.7%) and these were primarily fever (13.9%). Recurrence was seen in 5.6% and was mostly stromal keratitis (75.0%). Conclusion: Most cases of viral keratitis were unilateral, involving the epithelium, and occurred in young urban patients. Limited supportive diagnostic utility was seen with Giemsa staining, and triggers and recurrence were uncommon, but stromal involvement predominated for the recurrent cases, thus fulfilling the study objectives.

Keywords: Herpes Simplex Keratitis, Cornea, Giemsa staining, Recurrence.

Outline